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Chapter 20: Sexual Disorders: Sexual Dysfunctions and Paraphilias Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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2 Sexual Dysfunctions Etiology Physical/biologic Disease processes Medications Psychologic/behavioral Earlier experiences Anxiety/stress Misinformation Couple-oriented factors
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3 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Disorders Sexual desire disorders Sexual arousal disorders Female arousal Male erectile disorder Orgasmic disorders Delay or absence of orgasm Premature ejaculation
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4 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Disorders, cont’d. Sexual pain disorders Sexual dysfunction due to medical condition Substance-induced Not otherwise specified
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5 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Discharge Criteria Expresses satisfaction with sexuality Evidences knowledge of disorder Uses strategies appropriate to treat disorder Communicates with partner Copes with frustrations/setbacks
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6 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Assessment Nurse: Examine own feelings Establish rapport before progressing to sexuality information Sexual history
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7 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Nursing Diagnoses Anxiety Risk-prone health behavior Impaired comfort Impaired verbal communication Ineffective coping Defensive coping Fear Hopelessness
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8 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Nursing Diagnoses, cont’d. Deficient knowledge Chronic pain Ineffective role performance Situational low self-esteem Sexual dysfunction Ineffective sexuality pattern Social isolation
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9 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Client Outcomes Sexual Dysfunctions Client Outcomes IndividualizedExamples: Verbalize problem. Identify feelings. Schedule physical examination.* Participate in sex therapy.* Practice recommended strategies. *If indicated.
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10 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Planning Based on: Realistic criteria Mutually selected goals Client willingness to participate
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11 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Implementation View problem as couple-oriented Education Counseling Identification of strategies Referral Support
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12 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Nursing Interventions Teach sexual response cycle. Teach about sexual dysfunction. Help enhance communication skills related to intimacy/sexuality. Support exploration of fears/anxiety. Encourage positive self-talk, body image, exercises to increase self-esteem. Refer as appropriate.
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13 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Medical Testing (Male) Nocturnal penile tumescence Plethysmography Testosterone and prolactin levels Penile brachial index Ultrasound
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14 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Medical Testing (Female) Plethysmography Estradiol level Testosterone level
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15 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Treatment Modalities (Male) Sildenafil (Viagra) Apomorphine (Spontane) SSRIs Hormone replacement Yohimbine Intracarpal injections Prosthetic device Stop-start technique
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16 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Treatment Modalities (Female) Yohimbine Estrogen Testosterone EROS-CTD Vaginal dilators and relaxation
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17 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Treatment Modalities (Both) Sensate focus Homework assignments Supportive counseling Education Cognitive restructuring Masturbation training PLISSIT
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18 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias: Sexual Deviations Recurrent, intense, sexually-arousing fantasies, sexual urges, or behaviors involving nonhuman objects or suffering/humiliation of self, partner, children, or other nonconsenting persons
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19 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias Exhibitionism Fetishism Frotteurism Pedophilia Sexual masochism Sexual sadism Transvestic fetishism Voyeurism Not otherwise specified
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20 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias Etiology Biologic factors Chromosomal Hormonal Experiential factors History of sexual abuse Environmental factors Hereditary predisposition
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21 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias Discharge Criteria States nature of paraphilia: impact on self and others Identifies triggers Develops relapse prevention strategies Communicates and problem-solves appropriately Practices coping strategies Identifies support systems
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22 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias Assessment Perceptual disturbances Cognitive distortions Denial Rationalization Disturbances in feelings Lack of remorse Relating disturbances
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23 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias Nursing Diagnoses Ineffective coping Ineffective denial Interrupted family processes Deficient knowledge Noncompliance Ineffective sexuality pattern Impaired social interaction Risk for other-directed violence
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24 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias Outcome Identification State two sexually inappropriate behaviors. Identify triggers. Describe two coping strategies. List relapse prevention strategies. Actively participate in group therapy. Verbalize two appropriate sexual outlets. Explain importance of medication compliance.
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25 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias Planning Involve client Client-centered outcomes Mutually agreed on Realistic Affected by cognitive distortions
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26 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias Nursing Interventions Help client confront cognitive distortions: Direct questions Confrontation Journal writing Educate client and significant others about: Disorder Treatment Methods of relapse prevention
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27 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias Nursing Interventions, cont’d. Enhance compliance with treatment. Provide results of research. Teach coping strategies, assertiveness, and problem solving. Promote social skills development.
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28 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias Pharmacologic Treatment Medroxyprogesterone acetate (Depo-Provera) Leuprolide (Lupron Depot) Flutamide SSRIs
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29 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias Psychotherapy/Psychoeducation Address cognitive distortions Identify triggers Relapse prevention strategies Treatment compliance Self-esteem Coping strategies Problem solving
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